This document summarizes key topics from a chapter on medical-legal and ethical issues in emergency care, including scope of practice, patient consent and refusal, negligence, duty to act, and confidentiality. The chapter discusses legal concepts like implied consent, standards of care, and good Samaritan laws. It also covers special situations involving medical identification devices, organ donors, crime scenes, and reporting requirements for abuse or violence cases.

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Emergency Care
CHAPTER
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THIRTEENTH EDITION
Medical/Legal and
Ethical Issues
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Slide 7 Legal Issues in Healthcare Video
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Topics
• Scope of Practice
• Patient Consent and Refusal
• Other Legal Issues

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Scope of Practice
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Scope of Practice
• Regulations and ethical considerations
that defines the scope, or extent and
limits of an EMT's job
• May include skills and procedures
• Determined by national, state, local
laws, statutes, and protocols
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Standard of Care
• Care that would be expected from an
EMT with similar training when caring
for a patient in a similar situation
• Meeting standard of care reduces risk
of legal action
• Scope of practice
 What you can do
• Standard of care
 How you should do it

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Legal Issues
in Health Care Video
Click on the screenshot to view a video on the topic of legal issues in health care.
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Patient Consent and Refusal
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Consent
• Permission from patient to assess,
treat, and transport
• Expressed consent
 Must be informed
• Implied consent
 Assumed consent
 Follow local laws and protocols.
continued on next slide

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Consent
• Children and mentally incompetent
adults
 Minors not legally permitted to provide
consent or refusal for treatment
 Obtain from parent or legal guardian
 Possible exceptions (check local law)
• In loco parentis
• Emancipated minors
continued on next slide
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Consent
• Children and mentally incompetent
adults
 Possible exceptions (check local law)
• Life-threatening illness or injury
• Minors who have children
• Minors serving in armed forces
continued on next slide
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Consent
• Children and mentally incompetent
adults
 Adult patients incapable of informed
decisions about care
• State and local laws and protocols permit
transport of such patients under implied
consent
continued on next slide

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Consent
• Involuntary transportation
 Patient considered threat to himself or
others
 Court order
 Usually requires decision by mental
health professional or police officer
 If patient restrained, must not risk legal
liability
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When a Patient Refuses Care
• Patient may refuse care or transport
under the following circumstances:
 Patient must be legally able to consent.
 Patient must be awake and oriented.
 Patient must be fully informed.
 Patient will be asked to sign a "release"
form.
• Despite all precautions, EMT may still
be held liable.
continued on next slide
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When a Patient Refuses Care
• Take all possible actions to persuade
the patient to accept care and
transport.
 Spend time speaking with the patient.
 Listen carefully to try to determine why
the patient is refusing care.
 Inform the patient of the consequences
of not going to the hospital.
continued on next slide

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When a Patient Refuses Care
• Take all possible actions to persuade
the patient to accept care and
transport.
 Consult medical direction.
 Ask the patient if it is all right if you call
a family member—or advise the patient
that you would like to call a family
member.
continued on next slide
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When a Patient Refuses Care
• Take all possible actions to persuade
the patient to accept care and
transport.
 Call law enforcement personnel if
necessary.
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Think About It
• What are the risks of beginning
treatment and/or transport without
getting consent from the patient?
• What if the patient refuses to sign the
refusal of care form?

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When a Patient Refuses Care
• Subjecting the patient to unwanted
care and transport has actually been
viewed in court as assault or battery.
• Have witnesses to refusal.
• Inform patient that if they change their
mind, they can call back.
continued on next slide
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When a Patient Refuses Care
• If possible, have friend or relative
remain with patient.
• Document attempts thoroughly.
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Do Not Resuscitate Orders and Physician
Orders for Life-Sustaining Treatment
• Legal document expressing patient's
wishes if patient unable to speak for
self
• Do not resuscitate order (DNR)
 May be part of an advance directive
 May be part of a Physician Order for
Life-Sustaining Treatment (POLST)
• Should also be familiar with living wills
and health care proxies

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Other Legal Issues
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Negligence
• Something that should have been done
was not done, or was done incorrectly
• Must prove:
 EMT had duty to act
 Breach of duty
• EMT failed to provide standard of care
expected or failed to act
continued on next slide
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Negligence
• Must prove:
 Proximate causation
• Patient suffered harm because of EMT
action or inaction
• Negligent EMTs may be required to pay
damages.
continued on next slide

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Negligence
• Res ipsa loquitur (the thing speaks for
itself)
 Legal concept important in negligence
cases
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Duty to Act
• Obligation to provide care to a patient
• Duty to act is not always clear.
 Off duty
 On duty but out of jurisdiction
• Follow local laws and protocols.
• Follow own conscience.
continued on next slide
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Duty to Act
• Abandonment
 Once care is initiated, it may not be
discontinued until transferred to medical
personnel of equal or greater training.
 Failure to do so may constitute
abandonment.

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Good Samaritan Laws
• Grant immunity from liability if rescuer
acts in good faith within level of
training
• Rarely apply to on-duty personnel
• May not cover EMTs in some situations
• Do not protect persons from gross
negligence or violations of law
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Think About It
• You arrive on the scene of a patient in
cardiac arrest. The family says she has
a DNR, but don't know where it is. How
should you handle this?
• You are off duty and arrive on the
scene of a vehicle crash. Police and
EMS have not yet arrived. Are you
legally obligated to stop and render
aid?
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Confidentiality
• Information on patient's history,
condition, treatment considered
confidential
continued on next slide

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Confidentiality
• Privacy Rule of the Health Insurance
Portability and Accountability Act
(HIPAA)
 Information shared with other health
care personnel as part of patient's
continuing care
 Otherwise must be obtained through
subpoena
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Medical Identification Devices
Example of a medical identification device (front and back).
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Special Situations
• Medical identification devices
 For particular medical conditions
 Necklace, bracelet, or card
 Conditions include:
• Heart conditions
• Allergies
• Diabetes
• Epilepsy
continued on next slide

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Special Situations
• Organ donors
 Completed legal document allowing
donation of organs and tissues in event
of death
 May be identified by family members,
donor card, driver's license
 Receiving hospital and/or medical
direction should be advised per protocol
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Special Situations
• Safe haven laws
 Allow person to drop off an infant or
child at any fire, police, or EMS station
 States have different guidelines for ages
of children included
 Protect children who may otherwise be
abandoned or harmed by parents
unwilling or unable to care for them
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Crime Scenes
• Location where crime was committed or
anywhere evidence may be found
• Once police have made scene safe,
EMT's priority is patient care.
• Know what evidence is.
• Take steps to preserve evidence.

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Crime Scenes
• Examples of evidence
 Condition of the scene
 The patient
 Fingerprints and footprints
 Microscopic evidence
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Crime Scenes
• Preservation of evidence
 Remember what you touch
 Minimize your impact on the scene
 Work with the police
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Special Reporting Requirements
• Child, elderly, or domestic abuse
• Violence (gunshot wounds or
stabbings)
• Sexual assault
• Situations where restraint may be
necessary
continued on next slide

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Special Reporting Requirements
• Intoxicated person with injuries
• Mentally incompetent people with
injuries
• Check local laws and protocols.
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Chapter Review
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Chapter Review
• Medical, legal, and ethical issues are a
part of every EMS call.
continued on next slide

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Chapter Review
• Consent may be expressed or implied.
If a patient who is awake and oriented
and has the capacity to fully
understand his situation refuses care or
transport, you should make every effort
to persuade him, but you cannot force
him to accept care or go to the
hospital.
continued on next slide
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Chapter Review
• Negligence is failing to act properly
when you have a duty to act. As an
EMT, you have a duty to act whenever
you are dispatched on a call. You may
have a legal or moral duty to act even
when off duty or outside your
jurisdiction.
continued on next slide
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Chapter Review
• Abandonment is leaving a patient after
you have initiated care and before you
have transferred the patient to a
person with equal or higher training.
continued on next slide

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Chapter Review
• Confidentiality is the obligation not to
reveal personal information you obtain
about a patient except to other health
care professionals involved in the
patient's care, under court order, or
when the patient signs a release.
continued on next slide
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Chapter Review
• As an EMT, you may be sued or held
legally liable on any of these issues.
However, EMTs are rarely held liable
when they have acted within their
scope of practice and according to the
standard of care and have carefully
documented the details of the call.
continued on next slide
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Chapter Review
• At a crime scene, care of the patient
takes precedence over preservation of
evidence; however, you should make
every effort not to disturb the scene
unnecessarily and to report your
actions and observations to the police.
continued on next slide

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Remember
• EMTs must use good judgment and
decision-making skills when dealing
with patient consent and refusal.
• Avoiding negligence implies using good
judgment; critical thinking is an
essential component for avoiding
liability.
continued on next slide
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Remember
• EMTs hold responsibility for patients'
protected health information;
exercising care when dealing with this
information is a legal and ethical
obligation.
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Questions to Consider
• Define scope of practice, negligence,
duty to act, abandonment, and
confidentiality.
• What steps must you take when a
patient refuses care or transportation?
• What types of evidence may be found
at a crime scene? How should you act
to preserve evidence?

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Critical Thinking
• You respond to a motor vehicle crash
and find a seriously injured patient. He
has no pulse and you are about to
begin CPR when someone says, "Don't
do that! He's got cancer and a DNR!"
No one has the DNR at the scene. Do
you start CPR and transport the
patient?